Foot-and-mouth disease (FMD), also called hoof-and-mouth disease or aftosa, a highly contagious viral disease affecting practically all cloven-footed domesticated mammals, including cattle, sheep, goats, and pigs. Wild herbivores such as bison, deer, antelopes, reindeer, and giraffes are also susceptible. The horse is resistant to the infection.

South Korean health officials in protective gear preparing to slaughter pigs at a farm where …

Ha Sa-hun—Yonhap/AP

FMD is characterized by the formation of painful fluid-filled vesicles (blisters) on the tongue, lips, and other tissues of the mouth and on parts of the body where the skin is thin, as on the udder and teats, between the two toes of the feet, and around the coronary band above the hoof. Laboratory tests are needed to confirm the diagnosis because several other diseases can produce similar lesions. Because of its rapid spread and impact on animal productivity, FMD is considered to be the most economically devastating livestock disease in the world. The disease is not a human health hazard.

The foot-and-mouth virus is a picornavirus of the genus Aphthovirus. There are seven major immunologically distinct serotypes of the virus: A, O, C, SAT1, SAT2, SAT3, and Asia1. Each serotype includes a number of strains having different degrees of infectivity, virulence, and pathogenicity. Immunity to one serotype does not convey immunity to any of the others.

The virus is spread primarily by contact between infected and susceptible animals. An infected animal releases the virus in all excretions and secretions, especially during the onset of clinical signs. People can carry the virus on their hands (particularly under fingernails), clothes, and shoes and in their respiratory tract. Contaminated farm equipment and vehicles also can spread the disease, and the wind can transport aerosols containing the virus for several kilometres. There is no evidence that insects are involved in transmission.

The virus has an affinity for epithelium (the covering of the skin and mucous membranes of the gastrointestinal tract); it forms a primary vesicle where it gains entrance into the body. Within 24 to 48 hours, it enters the bloodstream, causing fever. A characteristic smacking of the lips then usually becomes prominent in the infected animal, ushering in the phase of the formation of vesicles on the tongue, gums, and lips. These vesicles rupture in about 24 hours, leaving raw, inflamed, and extremely painful surfaces that heal in one to two weeks. By this time the animal is refusing to eat solid food. Blisters also appear on the feet, causing lameness.

Eradication efforts begin as soon as a diagnosis of FMD has been made. The premises are quarantined, and all infected and susceptible animals on the premises frequently are euthanized and their carcasses buried or cremated. Because the virus can survive weeks to months in the environment, buildings and equipment must be thoroughly cleaned and disinfected and the premises left uninhabited for several months. Vaccination can help control outbreaks. Because the virus mutates continually, protection from one vaccination rarely lasts more than several months or a year. The availability of FMD vaccine banks enables rapid production of vaccines based on strains identified in a particular outbreak. For many years, the inability to distinguish between vaccinated and naturally infected animals necessitated mass culling during outbreaks. The development of marker vaccines with serological test kits, however, has now enabled most vaccinated animals to be distinguished from infected animals. Although rapid detection of the latter during an outbreak could save healthy animals from culling, the fact that there is a small chance for misdiagnosis means that most susceptible animals in outbreak areas are euthanized.

The losses caused by foot-and mouth disease are tremendous. The mortality in ordinary mild epizootics (animal epidemics) is only about 5 percent, but malignant forms of the disease have led to losses of up to 50 percent. In those animals that survive, great losses in weight occur because the animals cannot eat. In surviving milk-producing animals, the flow of milk is sharply diminished. Abortions and mastitis (inflammation of the breast or udder) are common, and secondary infections are frequent.

FMD is endemic in many regions of Asia, Africa, the Middle East, and South America. In the modern world, increased mobility of animals and people and increased density of animal populations are important factors in promoting the spread of FMD. North America has remained largely free of the disease because of a rigorous surveillance system; the last major outbreak in the United States was in 1929. In early 2001 a major outbreak occurred in the United Kingdom, where more than six million animals had to be slaughtered. Outbreaks in the Netherlands and France followed shortly. In response the United States temporarily banned importation of all ruminants and swine and their products from the 15-nation European Union. Cooked and cured meats were not included because heating and processing kills the virus. The last major outbreak in the United Kingdom prior to 2001 was in 1967.

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